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Foreign Exchange The entrance to Sderot’s protected underground city operations center, from which leaders worked during Operation Cast Lead. each stop where the shelters are located. They worry about her. “Who’s helping you?” is the fi rst question when Katz fi nishes speaking. Her response is nebulous. Dr. Katz says she was a liberal even by European standards—a pacifi st and a Jew who came home to help her people. She’s seen their fear for more than 15 years now. She’s experi- enced it too; fl uent in English, she speaks to the Americans in Hebrew because, she says, it’s “the language in which she knows fear.” The fear is also conditioning her—Dr. Katz says she feels herself changing. As the years have passed and the bombs kept coming and the town around her changed—some dying, some fl eeing, homes and businesses destroyed and rebuilt—she feels herself hardening, growing dark. She knows, of course, that the fear and suffering associated with Gaza and the Middle East and their confl icts aren’t confi ned to Israel’s side of the fence. The Gazans suffer too. She sees all this, recognizes it, regrets it, but what can she do? The bombs keep coming. When you go to Sderot, they tell you at When the siren comes, you have 15 seconds, move quickly but calmly. Katz’s clinic has one. The 2,000-square-meter covered indoor playground for Sderot’s children has two. The schools have been rebuilt to serve as them. So have the bus stops. Good thing, because the rockets are getting better. By the time of Operation Cast Lead, the Qassams’ range had increased from 3–4 km to 10–20, and their explosive payload from 0.5 kg to 10–20. Longer-range rockets have also been used to target more distant cities like Ashkelon and Ashdod. And just before the Americans’ arrival, a laser-guided Kornet antitank missile fi red into a school bus killed a 16-year-old. The local police are matter-of-fact when they show the Americans the piles of rockets. The retired school principal is more passionate. In the fortifi ed underground municipal operations center, from which the mayor, police and army ran things during Cast Lead, he ticks through the faces and names and videos of the victims, and damns early government half-measures to protect Sderot. He calls his city “Shelterstan.” Like Katz, his frustration is apparent. A parade of U.S. politicians have come and posed and spoken, Rick Perry and Mike Huckabee and then-candidate Barack Obama, but not much has changed. The projectiles keep coming, and to the people of Sderot, the world remains coldly ambivalent. Sometimes it blames them. The Bright Side of Red When the sirens come, they call it a red alert. The street vendor mentioned by Katz had fresh red watermelons for sale. He’d call that out as he pushed his cart down the street. Ultimately, the mere shouting of the word red, as the fruit man hawked his wares, was enough to trigger anxiety reactions and send people to Katz. Offi cials had to ask him to stop. While the body count in Sderot hasn’t been huge, what happens to people who endure such torment for years on end is. “I think,” said one of the Americans, Mike Spencer, a retired para- medic who once commanded EMS over half the city of Chicago, “if there had been a loud car backfi re while we were there that day, we’d have all been working.” If there’s a bright side, however, it’s this: Being under attack, traditionally and noncon- ventionally, for years on end can help a nation develop a pretty good emergency response system. Us Against the World Understanding the mind-set behind the Israeli emergency care system The Israelis are good at emergency care because they have to be. It’s a result of years of practice against both the missiles and mortars of traditional confl ict and the maiming mayhem of terrorists. It’s a mitigation against those attacks in the future. As Americans well know, the more trauma you see, the better you get at managing it. The same holds true for patient surges. What could be harder for Americans to understand is the psychology behind the Israeli approach. It comes from a unique set of circumstances. Israel was born after the Holocaust—after Hitler tried to wipe out the Jews. It was invaded immediately by its neighbors and has endured war and attacks throughout its existence. It’s surrounded today by states both hostile (Syria, Lebanon) and unstable (Syria, Egypt), and still sees a steady stream of horrifying acts against civilians. In March there were 128 attacks, per the coun- try’s General Security Service, including a bus stop bomb that killed a tourist in Jerusalem and the stabbing deaths of a West Bank family of fi ve—including an 11-year-old, 4-year-old and 3-month-old—in their beds. Taken together and repeatedly, that kind of stuff can really build an us-against-the-world mentality. Common enemies posing exis- tential threats do a lot to bring people together. In Israel that’s translated to a disciplined, coachable, participatory population with emer- gency response structures and mechanisms that are well-integrated, well-practiced and functional because they have to be. EMS WORLD JULY 2011 5